Enhancing the electronic health record to increase counseling and quit-line referral for parents who smoke.

Division of General Academic Pediatrics/Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Mass. Electronic address: msharifi@partners.org.

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Division of General Pediatrics, Boston University School of Medicine, Boston, Mass.

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Division of General Academic Pediatrics/Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Mass.

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Boston Public Health Commission, Boston, Mass.

Abstract

OBJECTIVE:

To assess the impact of an electronic health record (EHR) modification and brief clinician training on tobacco smoke exposure (TSE) management in pediatric primary care.

METHODS:

Within a teaching hospital-based, urban primary care setting, we modified the EHR to include TSE screening prompts, decision support, educational literature, and simplified referral to the state quit line (QuitWorks). A brief training was conducted for the 48 clinic physicians (34 residents and 14 attendings). We collected cross-sectional, independent, random samples of EHR data from well-child visits for children ≤12 years old seen 3 months before (2024 visits) and 3 months after (1895 visits) the intervention and pooled client data from QuitWorks to evaluate TSE screening, counseling, and quit-line referrals. A needs assessment questionnaire examined preintervention attitudes and practice around TSE management; follow-up questionnaires explored satisfaction and subjective changes in skills.

RESULTS:

The baseline needs assessment revealed that although most clinicians agreed that it is appropriate for pediatricians to conduct TSE screening, counseling, and referral during well-child visits, only about half screened, 42% counseled, and 28% routinely offered to refer smoking parents. In pre-post analyses of 117 and 112 EHR-documented positive screens, the intervention was associated with a 16-fold greater likelihood of counseling among positive screens (adjusted odds ratio 16.12; 95% confidence interval 7.28, 35.68). Referrals to QuitWorks increased from 1 before to 31 after the intervention.

CONCLUSIONS:

Implementation of EHR modifications and a brief training to support TSE management was associated with higher rates of counseling and quit-line referrals for parents who smoke.